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Medicina Oral, Patologia Oral Y Cirugia... Feb 2024Traditional protocols for implant surgery suggest a healing period of 2-3 months from dental extraction to implant placement. Based on all the volumetric modifications...
BACKGROUND
Traditional protocols for implant surgery suggest a healing period of 2-3 months from dental extraction to implant placement. Based on all the volumetric modifications produced by that approach, there are authors who advocate for immediate implantology. The aim of the present study was to determine the prevalence of different sockets, and the dimensions of the bone around the upper anterior incisors and canines, to determine the predictability of immediate implants in our population.
MATERIAL AND METHODS
This is an observational, cross-sectional study based on cone-beam computed tomography images of the anterior maxila of patients attending the Odontological Hospital of the University of Barcelona (OHUB) and requesting for implant treatment. Different measurements were performed on every analyzed tooth, and also they were categorized by using the main dental sockets classifications.
RESULTS
Bone attachment levels and cortical thickness are lower in women compared to men in all three types of teeth (the difference in the bone attachment levels ranges from 4.68%-8.63% and in the bone thickness goes from 0.02-0.58mm). Bone attachment level gradually reduces with age. The reductions observed in all the measurements are higher in the case of canines, compared with the other teeth. The differences from patients <45 years old and patients between 55-64 years old are 13.58±14.55mm in the case of central incisors, 10.04±5.52 in the case of lateral incisors and 22.39±13.65mm in the case of canines.
CONCLUSIONS
According to our results, the canines are the teeth with the greatest complexity when it comes to immediate implantology treatments. Furthermore, that kind of treatment is more complex as age increases, since we observed a gradual percentage of unfavourable sockets in older patients.
PubMed: 38368526
DOI: 10.4317/medoral.26269 -
Cureus Jan 2024The aim of this study was to assess and compare the likelihood of relapse one year after LeFort I advancement surgery in patients with and without cleft lip and palate.
PURPOSE
The aim of this study was to assess and compare the likelihood of relapse one year after LeFort I advancement surgery in patients with and without cleft lip and palate.
METHODS
A retrospective observational study which included two groups of participants who underwent LeFort I maxillary advancement was performed. Group 1 included 10 non-cleft subjects and Group 2 included 21 subjects with cleft palate. These maxillary deficient patients were chosen and operated using a technique where only a sagittal displacement was intended. Patients who underwent additional mandibular surgery, significant vertical or transverse alterations, or both were excluded. Pre-operative (T1), immediately post-operative (T2), and minimum one-year follow-up (T3) lateral cephalograms were studied for each group. Skeletal stability and dental stability after LeFort I surgery at a minimum of one-year follow-up in cleft palate and non-cleft patients were evaluated.
RESULTS
For the given sample size, relapse tendencies showed statistically significant differences between cleft palate patients and non-cleft palate patients after maxillary advancement. The sella nasion angle and horizontal overlap of the maxillary and mandibular incisors (overjet) decreased by 2 degrees and 0.9 mm respectively in the cleft palate group while decreasing by 1.10 degrees and 0.40 mm in the non-cleft group.
CONCLUSIONS
After maxillary advancement with LeFort I osteotomy and miniplate fixation in patients with cleft palate and non-cleft patients, some degree of relapse was detected in both groups for the given sample size after one year post-operatively. The cleft palate group displayed additional relapse tendencies when compared to the non-cleft group.
PubMed: 38357082
DOI: 10.7759/cureus.52298 -
BMC Oral Health Feb 2024This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this...
PURPOSE
This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets.
MATERIALS AND METHODS
A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05.
RESULTS
No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30).
CONCLUSION
Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.
Topics: Humans; Adult; Middle Aged; Dental Implants; Dental Implantation, Endosseous; Prospective Studies; Sinus Floor Augmentation; Maxillary Sinus; Maxilla; Treatment Outcome
PubMed: 38350895
DOI: 10.1186/s12903-024-03949-9 -
Case Reports in Dentistry 2024The osseodensification (OD) technique differs from conventional milling for dental implant installation in that it preserves the prepared bone and compacts it toward the...
The osseodensification (OD) technique differs from conventional milling for dental implant installation in that it preserves the prepared bone and compacts it toward the apex and lateral walls of the socket, resulting in bone compaction. By enabling autografting, bone expansion, and high implant insertion torques, OD has become an increasingly popular option. The aim of this clinical case report is to demonstrate the predictability of combining OD with guided bone and tissue regeneration (GBR/GTR) techniques for bone expansion in the maxilla with reduced thickness, while avoiding other reconstructive surgeries. The report presents the treatment of a 32-year-old female patient who had cosmetic concerns regarding the anterior maxillary region. The patient was using an adhesive prosthesis with pontic on tooth 13 fixed between teeth 12 and 14. After the case was planned, it was decided that bone expansion in the region would be performed using the OD technique. The implant installation (AR Torque, 3.5 × 11.5 mm, Conexão®) and guided bone regeneration (GBR) were done with the assistance of L-PRF (Stick Bone, associated with L-PRF membrane). Following the osseointegration period, a provisional resin crown was fabricated, and a collagen matrix membrane (Mucoderm®) was used to increase vestibular soft tissue volume and shape the patient's gingival profile. After a period of 120 days, the final crown was created and observed for a span of 5 years. The results showed stability of the case along with maintaining its esthetic and satisfactory function. The use of the osseodensification technique coupled with a connective tissue graft substitute has been anticipated for a long time. It has proven to be an excellent alternative to autogenous grafts.
PubMed: 38348345
DOI: 10.1155/2024/6509451 -
Cureus Jan 2024This case report shows an autotransplantation of the lower right cryopreserved third molar into the extraction socket of the lower right first molar. Due to deep caries...
This case report shows an autotransplantation of the lower right cryopreserved third molar into the extraction socket of the lower right first molar. Due to deep caries of the lower right first molar, the mesial root of this tooth was extracted. The patient asked to keep the distal root of the lower right first molar even if the root can survive only for a short period. So, a fixed partial denture supported by the lower right second premolar and the distal root of the lower right first molar was set. However, it was supposed that the distal root of the lower right first molar as an abutment tooth had a poor prognosis. Therefore, we also extracted the lower right third molar and cryopreserved to prepare autotransplantation if the lower right first molar has to be removed in the future. At first, the extracted third molar was frozen using a programmed freezer with a magnetic field named "Cells Alive System" (CAS) freezer, which was developed for tissue cryopreservation, and then, cryopreserved in the -150°C deep freezer. Eleven years later from the cryopreservation of the third molar, the lower right first molar showed root fracture. So, we extracted the lower right first molar and autotransplanted the cryopreserved third molar. Three years later, the autotransplanted tooth continued to be stable with healthy periodontium. The present case revealed that autotransplantation of a long-term cryopreserved tooth in a CAS freezer is a variable method to replace missing teeth.
PubMed: 38344636
DOI: 10.7759/cureus.52138 -
Journal of Clinical Medicine Jan 2024: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and... (Review)
Review
: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). : The PICO strategy was used to formulate the hypothesis under study: "For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?" The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. : Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results ( = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I = 45%), with no significant differences between studies ( = 0.91). Homogeneous results (I = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant ( < 0.00001) for this parameter. : Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).
PubMed: 38337515
DOI: 10.3390/jcm13030821 -
Medicina Oral, Patologia Oral Y Cirugia... Jan 2024Dry socket (DS) or fibrinolytic osteitis is a relatively common complication that can occur following tooth extraction. This study aimed to determine the prevalence of...
BACKGROUND
Dry socket (DS) or fibrinolytic osteitis is a relatively common complication that can occur following tooth extraction. This study aimed to determine the prevalence of DS and identify its associated predictive and mediating variables.
MATERIAL AND METHODS
This study is classified as prospective observational, cross-sectional, and multicenter. Patients were consecutively selected in accordance with established criteria for tooth extraction. Data on patient demographics, surgical procedures and postoperative outcomes were collected. Nominal variables were analyzed using the Chi-Square Test, while associations involving ordinal values or considering counts or layers were examined using the Kendall's Tau-B Test or Mantel-Haenszel Test for trend. The GLM Mediation Model was employed to investigate potential mediation or indirect effects or potential underlying mechanisms of predictive variables on the development of DS. Two-tailed significance level of p ≤0.05 was considered statistically significant.
RESULTS
A total of 1,357 patients undergoing routine dental extractions were included. DS was observed in 13 patients (prevalence of 1%). DS was associated with younger patients (under 50 years old), longer procedures, and the presence of surgical accidents, but only when mediated by surgical complexity. Smoking, particularly in combination with complex surgeries and surgical accidents, was associated with DS. Postoperative pain for more than two days and reported at moderate to high levels, emerged as a potential warning sign for DS. The use of antibiotics was found to significantly reduce the risk of DS (RR reduction of 36% and absolute risk reduction of 0.63%).
CONCLUSIONS
Routine dental extractions revealed a 1% prevalence of dry socket. The obtained results suggests that DS is a multifactorial condition influenced by various factors, including gender, age, smoking, antibiotic prescription and surgical factors such as length, technique and accidents, nevertheless, those associations were observed mainly considering the influence of one variable on another.
PubMed: 38288852
DOI: 10.4317/medoral.26391 -
National Journal of Maxillofacial... 2023Demineralized dentine matrix (DDM) has both osteoconductive and osteoinductive properties, and has porous structure which helps in cell and blood vessel penetration and...
Demineralized dentine matrix (DDM) has both osteoconductive and osteoinductive properties, and has porous structure which helps in cell and blood vessel penetration and the release of various growth factors from the dentinal tubules. The first human dentine autograft case was done in 2002 in Japan for maxillary sinus lifting. In this clinical report, we use a hand-operated order made stainless steel apparatus to crush the tooth and prepare the DDM chair side. Chemical treatment of DDM particulate was done for demineralization and sterilisation purpose, and used immediately as a graft material for socket preservation. Dentascan after 4 month showed remarkable bone at the site of grafting and implant was placed. The patient was restored successfully with their own DDM and implant-supported prosthesis.
PubMed: 38273928
DOI: 10.4103/njms.njms_47_22 -
International Journal of Clinical... Nov 2023The aim of this article is to report a case of multiple radicular cysts in an 8-year-old.
AIM
The aim of this article is to report a case of multiple radicular cysts in an 8-year-old.
BACKGROUND
Multiple radicular cysts are an uncommon and rare entity in mixed dentition. Management of these cysts needs careful examination of the present deciduous and erupting permanent dentition. Here, we present a case of multiple radicular cysts in an 8-year-old with no other significant medical history. The treatment approach included removal of the involved deciduous teeth and enucleation of cysts, followed by curettage and the use of Whitehead's varnish.
CASE DESCRIPTION
The patient reported to the department with a chief complaint of pain in the right lower front tooth region and upper left back tooth region for 2 months. There was no relevant medical or dental history. A routine panoramic radiograph was done, which revealed multiple radiolucency. Clinical presentation, radiograph, and aspiration cytology concluded the diagnosis as multiple radicular cysts. The treatment plan for management was the extraction of the teeth involved, followed by enucleation. Whitehead's varnish dressing was placed in the extraction socket. A regular follow-up was done, showing the absence of radiolucency and eruption of permanent teeth.
CONCLUSION
Management of radicular cysts in mixed dentition is challenging. Preserving the vitality of erupting permanent teeth is of utmost importance.
SIGNIFICANCE
Multiple radicular cysts are an uncommon finding in young children. Proper medical history is important to rule out any syndrome. Correct diagnosis and early management are prognostic factors.
HOW TO CITE THIS ARTICLE
Sharma A, Chhabra A, Sharma I, Multiple Radicular Cysts in an 8-year-old: A Case Report. Int J Clin Pediatr Dent 2023;16(S-3):S317-S320.
PubMed: 38268627
DOI: 10.5005/jp-journals-10005-2700 -
Cureus Dec 2023Nasal cartilage is asymmetric in individuals with cleft lips and has a depressed nasal dome and medial and lateral crus of the nose on the affected cleft side which can...
Nasal cartilage is asymmetric in individuals with cleft lips and has a depressed nasal dome and medial and lateral crus of the nose on the affected cleft side which can be corrected before cheiloplasty by taking advantage of circulating maternal estrogen. This case report presents pre-surgical nasal cartilage molding in a patient with unilateral cleft lip and alveolus using the Sawangi Pre-surgical Nasal Cartilage Molder appliance. The appliance is made from 0.8 mm stainless-steel round wire and has three components, namely, a rectangular frame, a force-generating component, and a swan-shaped wire framework with a soft liner for nasal asymmetry correction.
PubMed: 38259383
DOI: 10.7759/cureus.50998